Provider Demographics
NPI:1952381584
Name:C.H. HUGHES
Entity Type:Organization
Organization Name:C.H. HUGHES
Other - Org Name:DYERSBURG PEDIATRIC DENTISTRY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:731-286-1271
Mailing Address - Street 1:95 HWY 51 BYPASS WEST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024
Mailing Address - Country:US
Mailing Address - Phone:731-286-1271
Mailing Address - Fax:731-286-8034
Practice Address - Street 1:95 HWY 51 BYPASS WEST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024
Practice Address - Country:US
Practice Address - Phone:731-286-1271
Practice Address - Fax:731-286-8034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN14860Medicaid